• O2 as needed. Use the following rates as guidelines:

    • 2 LPM by nasal cannula (NC) for patients with COPD, or as prescribed.

    • 4-6 LPM by NC for other patients

    •  8-10 LPM for nebulized meds

    • 12-15 LPM by non-rebreather mask (NRM) for severe trauma patients, distressed cardiac patients, patients with respiratory distress, and other patients who appear to need high flow O2.

  •  Ventilate symptomatic patients who have insufficient respiratory rate or depth.

  •  If routine ventilation procedures are unsuccessful, try to visualize obstruction with laryngoscope. If a foreign body is seen, attempt to remove it using suction, or Magill forceps.


Up to 1 year    30-60                    7-9 years    16-24

   1-3 years     20-40                 10-14 years    16-20

   4-6 years    20-30                    15+ years     12-20

  • Consider patient airway anatomy for the appropriate selection of the airway adjunct. 
  1.  If two attempts with an ETT are not successful, move to an adjunct device.
    • If two attempts with an ETT are not successful, move to an adjunct device.

P Supraglottic airway is recommended as the primary airway except in extreme cases such as airway edema.

  • Confirm correct placement of advanced airways by at least five methods.

P  For patient < 2 years old showing respiratory distress with nasal congestion, cough, rales, rhonchi or wheezing - without previous history of wheezing, reactive airway disease, breathing treatments:

Nasal suction both nares (3-5 seconds) with an appropriate device and apply oxygen as required. If distress continues, repeat nasopharyngeal suction with an appropriately sized and lubricated suction catheter x 1, for 3-5 seconds.

NOTE: Repeated and prolonged suctioning could cause hypoxia and bradycardia.


P If patient does have history of reactive airway disease with prescribed breathing treatments treat with asthma protocol.:

P For patients < 6 years old without a foreign body showing respiratory distress with agitation, upper airway noise, stridor, and/or “barky cough”, lower temperature of ambulance as much as possible. Use oxygen as the patient tolerates. Oftentimes symptoms resolve with less intervention. Consider keeping distance from the patient. :


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